Legalizing Medical Marijuana

Harold E. Cohen, RPh
Editor-in-Chief

US Pharm. 2010;35(1):4.

A recently published article in the open-access journal BMC Neurology extols the virtues of cannabis in reducing spasticity in patients with multiple sclerosis. The results were published after a systematic review of randomized, controlled trials uncovered a reduction in spasticity and an improvement in mobility in five out of six of the trials. This is not the first time the medical literature has reported the benefits of medical marijuana for a variety of conditions, including the alleviation of excruciating pain, nausea, and vomiting and for appetite stimulation, and I believe it won’t be the last. Yet lawmakers continue to resist any change to marijuana’s legal status at the federal level.

In 2005, the Supreme Court ruled in Raich v. Gonzales that the federal government could prosecute patients using medical marijuana, even in the 13 states that have enacted state laws allowing the cultivation of the plant for medicinal purposes. While the debate on legalizing medical marijuana between state and federal governments rages on, Congress has made some progress in the legalization process. It has attempted to pass an amendment to the Justice Department spending bill that would have prohibited the department from spending any money to undermine state medical marijuana laws, thereby protecting patients who use medical marijuana for legitimate medical purposes. While this bill has been brought up twice since the 2005 Supreme Court ruling and was defeated both times, the last time it was voted on it was defeated by a smaller margin. At least Congress seems to be moving in the right direction.

The debate over legalizing marijuana is ongoing despite support by respectable medical organizations for its legalization. For example, a 1999 report from the Institute of Medicine concluded, “The accumulated data indicate a potential therapeutic value for cannabinoid drugs.” It also put to rest the notion that legalizing medical marijuana would lead to increased of marijuana use in the general population by stating that “at this point there are no convincing data to support [that] concern.” It goes on to say that there would be no problem “if the medical use of marijuana were as closely regulated as other medications with abuse potential.” To be clear, the report was not cavalier in its approach to using medical marijuana. “[Marijuana] is a powerful drug with a variety of effects,” said the report. “However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications.”

So why all the push-back when it comes to legalizing medical marijuana? Is it because marijuana is portrayed in the media as more of a social drug than a medicinal one? Is it because the perception is that marijuana is more harmful socially than alcohol? While alcohol is not classified as a drug, its effects mimic those of many prescription drugs, and in fact it can be as lethal as a drug if ingested in large quantities. Given the body of evidence that marijuana can be an effective drug for certain medical conditions, I am hard pressed to find a solid reason for not legalizing medical marijuana and subjecting it to the same controls as other Schedule II drugs.

I say let the FDA allow pharmaceutical companies to carry out controlled clinical trials to see if medical marijuana lives up to the hype being promulgated in the literature. If the results are positive, the FDA should then give its stamp of approval as it would for any drug, and the Supreme Court should reconsider its position. Pharmacists should endorse this course of action because, if it is approved, they are the ones who will ultimately be responsible for dispensing medical marijuana, not some storefront retailer or street-corner drug dealer.

Editor’s Note: On January 11, 2010, New Jersey became the 14th state to legalize the use of marijuana for medical purposes. It will be one of the most restrictive medical marijuana laws in the nation. Only patients with certain severe illnesses such as AIDS, cancer, Lou Gehrig’s disease, and multiple sclerosis, among others, will be eligible for a prescription.